Thank you for joining us today!. Please dial 1.800.732.6179 now to connect to the audio for this webinar. To show/hide the control panel click the double arrows. Presentation by Christopher Millett and Brian Hutchison Wednesday, September 23, 2009. What is pay for performance?.
Thank you for joining us today!
Please dial 1.800.732.6179 now to connect to the audio for this webinar.
To show/hide the control panel click the double arrows.
Presentation by Christopher Millett and Brian Hutchison
Wednesday, September 23, 2009
What is pay for performance?
DM 2 The percentage of patients with diabetes whose
notes record BMI in the previous 15 months
(3 points – threshold 40-90%)
DM 8 The percentage of patients with diabetes who have
a record of retinal screening in the previous 15 months
(5 points – threshold 40-90%)
DM 6 The percentage of patients with diabetes in
whom the last HbA1C is 7.4 or less in last 15 months
(17 points – threshold 40-50%)
Focused on activities (outputs) rather than quality (processes) of care
Output incentives primarily address access concerns
P4P incentives are available to physicians participating in patient enrollment models
Mix of incentives varies across payment models
Graduated bonuses for achieving target
levels of provision of preventive services to
Colorectal cancer screening
Payments for providing priority services above threshold levels (e.g., obstetrical deliveries, palliative care, minor surgery, home visits, hospital care, and care of patients with chronic mental illness)
Fees for contacting patients to schedule appointments for screening and prevention
Fees for enrolling unattached patients
Fee for completion of diabetic care flow sheet
Premiums for after-hours care
Add-on smoking cessation counseling fee
What is the evidence that pay for performance has worked?
Christianson JB. Med Care Res Rev. 2008
Petersen LA. Ann Intern Med. 2006
Are there unintended consequences?
Millett C. Diabetes Care 2009
California P4P (McDonald, Annals Family Medicine 2009)
“I told someone, you’re killing my pay for
performance. Go join another medical group”
Older patients, women, those with comorbidity
more likely to be excluded (Simpson, BMC Fam Prac. 2007)
Campbell et al. N Engl J Med. 2009
For complex tasks, extrinsic incentives tend to reduce intrinsic motivation and performance unless they are consonant with personal and professional interests, values and sense of self
Deci et al.Psych Bulletin 1999
Gagné and Deci. J Org Behavior 2005
What are the prerequisites for implementation?
Does it deliver value for money?
- Importance of investing in primary care
How to ask a question…
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